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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603787
Report Date: 01/30/2025
Date Signed: 01/30/2025 10:32:56 AM

Document Has Been Signed on 01/30/2025 10:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VARDA HOME INCFACILITY NUMBER:
198603787
ADMINISTRATOR/
DIRECTOR:
MARKOSIAN, ARMENFACILITY TYPE:
740
ADDRESS:1744 E ELIZABETH STTELEPHONE:
(626) 888-7858
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 6CENSUS: 5DATE:
01/30/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:44 AM
MET WITH:Armen Markosian, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) S Vaid conducted a Post Licensing visit to the facility. LPA met with Karine Chilingaryan caregiver who allowed access to the facility. Administrator, Armen Markosian was informed and explained the reason for the visit. The facility has a fire clearance approved for 5 non-ambulatory residents of which 1 may be bedridden.

The visit began with a tour of the facility. Resident rooms were randomly inspected and were observed to have sufficient space and furniture. Bathrooms had grab bars and non-skid mats. The water temperature measured between 105-120 degrees F. The common areas were observed to be appropriately furnished. The kitchen was inspected. The area was clean, and appliances seem to be operating properly. Food supply was adequate, and food was stored properly. There are no large bodies of water on the premises. The outside recreation area has a fence around the entire perimeter. Facility has an operating auditory device on exit doors, and LPA observed and its operational.

Smoke detectors were working properly, fire extinguisher was fully charged and operational, chemical compounds and knifes were locked and inaccessible to clients. Staff files were not on the premises, staff files not reviewed. Resident files were randomly reviewed. All required documentation such as physician's reports and admission agreements were observed. The medication was inspected, and medications were reviewed.

One deficiency cited on 809D page, exit interview conducted, copy of report and appeals rights provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/30/2025 10:32 AM - It Cannot Be Edited


Created By: Sanjay Vaid On 01/30/2025 at 10:18 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VARDA HOME INC

FACILITY NUMBER: 198603787

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2025
Section Cited
CCR
80066

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Personnal records- 80066. Staff personnel records must be available at all times. Facility must ensure all staff records to be on the premises at all time for future inspection.
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Administrator will submit staff documents to LPA by 02/10/2025.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Fernando Fierros
LICENSING EVALUATOR NAME:Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2025


LIC809 (FAS) - (06/04)
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